Italy has been one of the countries worst affected by COVID-19, with 24,747 recorded cases so far, and 1,809 deaths. Last week, Italian Prime Minister Giuseppe Conte declared the entire country a “protected zone,” placing it under total lockdown: all but the most essential services are shuttered and people are required to obtain permission to leave their homes until early next month.
Martina Angi is an ocular oncologist at the National Cancer Institute in Milan. We spoke to her to get a sense of how the quarantine has been put into effect in Milan and the entire country, and what it took for the Italians to adhere to it. She also walked us through the healthcare system’s initial response and the change of course.
Mada Masr: Tell us about the quarantine and how it evolved to become heavily respected by people.
Martina Angi: Schools here have been closed for three full weeks now. At the beginning, it felt a bit like a holiday, especially since it was happening during a carnival. So people were going out in the open air. We had all seen pictures of the strict quarantine in Wuhan, but no one felt that it was going to be necessary in our case. We had two towns that were identified as red zones: Codogno in Lombardy and Vo’ Euganeo in Veneto. These towns had to go on total lockdown and television started showing footage of what was happening. Everyone else in the affected regions pretty much kept having a normal life, just paying more attention to hand washing, etc. There was this hashtag “Milano non si ferma”, which means Milano doesn’t stop. People were going to bars and local stores, although there was social distancing. Initially, the reaction to the school closures was negative. For more than a week, people were almost against it, deeming it an imposed or unnecessary measure.
Things changed drastically a week ago [March 7] when the entire Lombardy region and some neighboring cities were designated red zones. No one could get in or out of the area, people were encouraged to work from home, and all kinds of gatherings (including sports, religious functions, etc) have been canceled. This still was not enough to prevent people from gathering in bars, taking public transport etc, so since March 11 there has been a total lockdown: everything is closed but food stores and essential services. There is no one out in the street, and people are not allowed to leave their homes except for documented reasons. I go to work at the hospital every day on my bike for 10 minutes and it feels like a treat.
MM: What prompted the change?
MA: The virus is spreading incredibly fast — too many people are getting sick at the same time and putting enormous pressure on the health system. After 14 days of the lockdown in the two towns that were originally identified as red zones, zero new cases have been identified in these places now. But in Bergamo [a town near Milan], the problem was not recognized early on and cases have multiplied exponentially. This made people recognize the problem and shut things down.
MM: Besides people internalizing the necessity of the quarantine, what role is the government playing there?
MA: The government has recently issued a country-wide lockdown, with only essential services left up and running. It is forbidden to be out and about. If you leave the house, you have to carry a certificate stating why you are out and there are roaming police patrols. People mostly only go out to get their provisions and only a few food stores are open — there are long queues and people keep their distance. People in general understand. It feels like wartime, and the emptiness, the face masks and all that have set a new tone altogether. It is scary.
MM: How have people been coping with this?
MA: There has been a lot of community networking. And generally, people who tend to have strong opinions and be critical of the system have come to terms with the fact that this crisis is really scary, and that a new rhythm has to be followed. Families are checking on each other. Neighbors are checking on each other. I can say something good is coming out of this, in terms of social cohesion. But of course, the worrying thing is the socioeconomic effect of the quarantine, and this is something people are worrying about.
MM: So what were the early responses that caused the crisis and were later deemed a mistake by Italian officials?
MA: At the beginning, there had been a lot of attention toward people coming back from China, who were quarantined in dedicated infectious disease hospitals. The policy at the beginning had been to trace and isolate infected cases and test people they came into contact with. But the problem is that many people with respiratory symptoms and no apparent ties to China were going in and out of the emergency rooms in the hospitals and no one imagined it could be COVID-19 rather than seasonal flu. With the two-week incubation period and range of symptoms, a much wider group of people are carrying the virus than those originally sought out by the authorities, and social distancing is indeed the only way to contain it. So now all efforts are toward making people stay at home. There is a telephone triage system to screen potentially affected patients without sending them to the hospital, and anyone with a fever and respiratory symptoms is considered at risk irrespective of the contact the individual has had.
MM: COVID-19 is highlighting a crisis in healthcare worldwide. How is this manifesting in Italy?
MA: There is a free and accessible public healthcare system in Italy but there have been some major cuts over the last 30 years. The numbers of doctors, nurses and ICU beds have been reduced. With the increase in COVID-19 cases, there is no place in hospitals for everyone, especially because those COVID-19 patients who need the ICU end up staying there for a long time, so there is no turnover for new patients. Lombardy, which is the most affected region in Italy, also has probably the most efficient health system in the country, but nevertheless it’s struggling. We went from having select hospitals dedicated to treating COVID-19 patients, to all hospitals with a few exceptions (such as the cancer institute) turned into COVID-19 hospitals. This means that people suffering from other diseases, even severe ones, have no place in these hospitals and risk dying of otherwise treatable causes such as a heart attack.
MM: As a doctor yourself, and someone following the quarantine with the rest of your country, where does hope lie for you?
MA: We know from the Chinese experience that this epidemic can be stopped with strict social distancing. I really hope that people understand the bigger picture and, even if they are young and healthy, stay at home to protect those who would not survive the infection.